In earlier stages of the pandemic, the states with the most coronavirus cases often bordered one another. Major outbreaks were concentrated in geographic regions of the United States: the Northeast in the spring, the Sun Belt over the summer and the country’s midsection in the fall.
Now, the five worst-hit states are scattered around the country: Arizona, California, Oklahoma, Rhode Island and South Carolina are averaging the most daily new cases per person, according to a New York Times database.
One threat they have in common is the post-holiday surge of the virus that has thrust the United States into its darkest days of the pandemic, with cases rising in nearly every state. The country reported 300,594 new cases on Friday and more than 4,100 deaths on Thursday, both single-day records. In total, more than 374,000 have died from Covid-19 in the United States.
The emergence of more contagious variants has added urgency to the country’s vaccine rollout, which has gotten off to a slow start.
In November, most of the worst-affected states were in the Upper Midwest and Mountain West. Wisconsin had been a focus for its startling positivity rates — over 30 percent at one point — and its field hospitals reopening. As soon as those cases started to decline, states like Indiana, Kansas and Rhode Island had surges.
“It never really dropped,” said Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We transferred risk from one area to another.”
He believes people restrict their socializing habits when they experience an outbreak and then relax them when the numbers go down, leading to new surges.
Here’s a snapshot of how the five worst-off states are grappling with the virus:
Arizona, for the second time, is shattering its records and reporting more new cases each day per capita than any other state. Nearly 5,000 Arizonans were hospitalized with the virus as of Sunday — more than in July, the state’s previous peak. Vaccines are being administered at among the lowest rates in the country.
California’s devastating surge is concentrated in the southern part of the state, where emergency rooms have had to shut their doors to ambulances for hours at a time. Nearly one in 10 people have tested positive for the virus in Los Angeles County, the nation’s most populous. The surge of hospitalizations has caused problems for the oxygen delivery and supply system used by medical facilities.
In Oklahoma, daily caseloads have increased 40 percent in the past two weeks. Overstretched hospitals have put patients in hallways and converted conference rooms into treatment areas, The Tulsa World reported. The state’s online vaccine portal, to avoid crashing, took up to 48 hours to send emails confirming registrations, causing confusion for many.
Rhode Island, which aggressively handled its spring surge, has the worst outbreak of any Northeastern state. After the start of the school year in early September, case numbers began climbing steadily and have not slowed. It had a seven-day average of 130 cases per 100,000 people, the highest per capita rate in the country. One factor, experts say, is the state’s population, which is poorer, older and more densely packed than its neighbors’.
South Carolina has more than doubled its average cases over the past two weeks. More than 30 percent of coronavirus tests given over the past week were positive, according to state data, and five counties reported their hospitals’ acute care beds were full, The Post and Courier reported. The state ranks among the nation’s lowest in its vaccine administration rate, according to Centers for Disease Control and Prevention data compiled by The State, with many health care workers hesitant to get inoculated.
Across the country, many big cities like New York have struggled to resume even limited in-person instruction, while several, including Los Angeles, have simply given up on the idea, choosing to stick with all-remote education into the spring.
Few places have seen as much acrimony over the issue as Chicago, whose public school system is the nation’s third-largest. Now, with 6,000 prekindergarten and special education students preparing to return to the city’s public school buildings on Monday for the first time since March, a question looms: How many teachers will be there to greet them?
Mayor Lori Lightfoot of Chicago has argued that giving parents the option of sending their children to school in person is critical to preventing some of the city’s mostly poor and Black and Latino students from falling permanently behind.
But the teachers’ union has fiercely resisted the plan, arguing that schools are not safe while the coronavirus is surging. Over the past week, less than 60 percent of the roughly 2,000 teachers who were expected to return to their buildings to prepare for the arrival of students actually showed up.
Janice K. Jackson, the chief executive of the school system that serves about 350,000 students, said on Friday that she was optimistic that most teachers would go to work on Monday. She warned that any who stayed home without permission would not be paid, raising the prospect of a heightened clash with the union, which has suggested it may strike if teachers are not permitted to stay home if they want to.
“This is probably the most contentious and unpleasant reopening in terms of how the different sides are interacting with each other,” said Emily Oster, an economics professor at Brown who has collected data on coronavirus cases in schools and has argued that reopening schools is safe under many circumstances.
In other developments around the United States:
While sheltering in a secure location as a mob of Trump supporters stormed the Capitol on Wednesday, House lawmakers may have been exposed to someone who was infected with the coronavirus, according to the Office of the Attending Physician. In an email to lawmakers on Sunday, the attending physician to Congress, Dr. Brian P. Monahan, urged them to obtain a P.C.R. test as a precaution and to continue taking preventive steps against the spread of the virus.
Five new coronavirus vaccination centers opened in New York, in the latest effort to accelerate the sluggish pace that has dogged the rollout in the city. Two sites are mass vaccination centers that, starting Monday, will operate 24 hours a day, seven days a week, according to the city Department of Health.
Delays were reported at Ronald Reagan Washington National Airport after an air traffic control center that serves the area reported a coronavirus infection and closed for cleaning on Sunday, the Federal Aviation Administration said.
President-elect Joseph R. Biden Jr. is scheduled to receive his second dose of the Pfizer-BioNTech Covid-19 vaccine on Monday. Mr. Biden received the first dose on live television last month.
Indonesia on Monday authorized emergency use of a Covid-19 vaccine made by a private Chinese company after late-stage clinical data reaffirmed that the shot is effective, clearing the way for a mass vaccination program to begin in the country.
At a news conference, Indonesia’s Food and Drug Administration said it had endorsed the vaccine developed by Sinovac, a Beijing-based vaccine maker, after its interim analysis showed that the inoculation had an efficacy rate of 65.3 percent.
Jarir At Thobari, a representative for the National Committee for Drug Assessment, said the efficacy rate of CoronaVac, the name of the Sinovac vaccine, was lower compared with the recent announcements from Sinovac’s trials in Brazil and Turkey because the Indonesia trial was made up of members of the general public, compared with the volunteers in Brazil and Turkey, who were health care workers or from high-risk groups. A higher number of people who are infected would bring the efficacy rates higher, Dr. At Thobari said.
Prof. Kusnandi Rusmil, head of the Covid-19 vaccine research team at Padjadjaran University, which is running the Phase 3 trials, said that of the 25 people who got Covid-19 during the trial, seven were vaccinated and 18 were in the placebo group.
Brazilian officials said last week that CoronaVac had an efficacy rate of 78 percent. Turkish officials said earlier that the vaccine had an efficacy rate of 91.25 percent, though it was based on preliminary results from a small clinical trial.
Inoculations are set to begin in the coming weeks with health workers, soldiers and police officers. Indonesia has recorded nearly 840,000 coronavirus cases and more than 24,000 deaths. It hopes to achieve herd immunity by vaccinating roughly two-thirds of the population in just over a year.
Indonesia has ordered vaccines from several companies, but plans to rely mostly on Sinovac, which has already delivered three million doses.
Separately, the Philippines said on Monday that it had secured 25 million doses of the Sinovac vaccine, with the first 50,000 doses set to arrive by February. The Philippine Department of Health has been accused of botching an earlier opportunity to secure 10 million doses of the Pfizer-BioNTech vaccine as early as this month.
And in the Seychelles, an archipelago nation in the Indian Ocean about 1,000 miles east of Kenya, the government said in a statement released on Sunday that the country’s vaccination campaign had begun with President Wavel Ramkalawan, who received the Sinopharm vaccine. The United Arab Emirates, which last month became the first country to authorize a Chinese coronavirus vaccine, has donated 50,000 doses of the Sinopharm vaccine to the Seychelles, the statement said, while India has offered 100,000 doses of the Oxford-AstraZeneca vaccine. According to the Ministry of Health, the Seychelles has recorded 531 coronavirus cases and one death.
Across New York State, medical providers had the same story in recent weeks: They had been forced to throw out precious vaccine doses because of difficulties finding patients who precisely matched the state’s strict vaccination guidelines — and the steep penalties they would face had they made a mistake.
On Saturday, state health officials responded to the outcry over discarded vaccines by again abruptly loosening guidelines as coronavirus cases continued to rise.
Now, medical providers can administer the vaccine to any employees who interact with the public if there are extra doses in a vial and no one from “the priority population can come in before the doses expire,” the new guidelines read. A pharmacy’s “store clerks, cashiers, stock workers and delivery staff” could qualify, the guidelines said.
It was the second time in two days that Gov. Andrew M. Cuomo’s administration had loosened the restrictions around who can get vaccinated in New York State. The governor announced on Friday that medical providers could vaccinate a wider range of essential workers and New Yorkers 75 years and older starting as early as Monday.
The new, more forgiving guidelines highlight the difficulties the state has had in balancing the need to vaccinate vulnerable populations quickly with the imperative to prevent fraud and favoritism in the distribution process.
Neil Calman, whose Institute for Family Health had to discard unused vaccine doses, hailed the rule change, but argued for yet more loosening of guidelines to allow for vaccinations of at-risk patients with conditions like diabetes, obesity and heart disease who are younger than 75.
“We’re seeing them in our office, and it just seems like we’re turning them away today just so we can call them back in a week and say, ‘Now you can get your vaccine,’” Dr. Calman said.
Russian vaccine scientists on Monday began a study to determine whether they can hasten the country’s campaign of coronavirus inoculations by providing only a single dose of its normally two-dose vaccine.
The idea, also under consideration in Britain and other countries, is that a single dose could provide more than half of the protection offered by a two-dose vaccine. While each vaccinated person would be less protected than if they had undergone the full inoculation cycle, the approach could potentially save more lives in the population as a whole.
Russia’s vaccine, called Sputnik V, uses two types of genetically modified human adenoviruses, which are common cold viruses. The new approach would administer only a single type of the cold virus in one shot, the group that developed the vaccine, the Gamaleya Research Institute, said on Monday.
The institute, part of the Russian Ministry of Health, will study the single-dose approach, called Sputnik Light, in 150 volunteers in Moscow and St. Petersburg. It was not clear when it hoped for results or when Russia might decide whether to switch tack to a single-dose strategy.
The institute’s director, Aleksandr Gintsburg, said in December that the single shot was likely to prove about 85 percent effective but would vary for different categories of patients. The two-shot regime showed an efficacy rate of 91.4 in clinical trials. President Vladimir V. Putin suggested the new tactic in December.
In the United States, President-elect Joseph R. Biden Jr. plans to end the practice of reserving the second shots of two-dose Pfizer and Moderna vaccines for those who have received a first shot. His administration would instead distribute nearly all available vials immediately.
But Biden officials do not intend to forgo the second shot; vaccine production, they have said, is expected to ramp up to meet demand for second shots. The Food and Drug Administration has recommended against tweaking the dosage schedules, which have been carefully studied in clinical trials.
China is experiencing its worst coronavirus flare-up in months, but that hasn’t stopped an ice and snow festival from going ahead as planned in the northeastern city of Harbin.
The annual festival, which is the largest of its kind in the world and normally draws millions of visitors, features colossal snow and ice structures that are elaborately carved over weeks by hundreds of workers and illuminated by colored LED lights. Last year, the festival shut down early after the central government imposed a strict lockdown on millions of people in Hubei Province, the central region where the coronavirus is believed to have originated. Harbin, a city of 10 million people near the Russian border, experienced its own outbreak last spring.
Though life in most parts of China has largely returned to normal, a recent outbreak in the northern province of Hebei has led the government to impose a stay-at-home order on more than 17 million people in two cities there. On Monday, officials reported 85 new locally transmitted infections, mostly in Hebei.
That announcement came one year to the day after Chinese state media reported the first known death from the coronavirus in Wuhan, the capital of Hubei Province. Since then, the virus has claimed the lives of more than 1.9 million people worldwide, according to a New York Times database. China’s official death toll is 4,634.
The winter festival in Harbin, which opened last month, is a popular destination during the Lunar New Year holiday, China’s busiest travel period. With the country’s borders closed to foreign tourists, most visitors this year are coming from around China. All visitors are required to show a “health code” on a contact-tracing app and have their temperatures measured before entering venues. Several events and performances that would have encouraged crowds have been canceled.
China also said on Monday that a team of investigators from the World Health Organization would be arriving on Thursday to begin an inquiry into the origins of the coronavirus. Last week, Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O., took the rare step of publicly criticizing China for blocking the team from entering the country even though some members were already in transit. The details of the W.H.O. team’s visit have not yet been announced.
In other developments around the world:
The health care system in Britain is facing “the worst weeks of this pandemic,” the government’s chief medical officer, Prof. Chris Witty, said on Monday, adding that hospitalizations in England had already far surpassed the spring’s peak. “This is an appalling situation,” Professor Witty told the BBC, warning that the impact of the vaccines would not be felt for several weeks. Seven new vaccination centers are set to open across England this week, with the government hoping to offer a vaccine to every adult by the fall.
Primary schools and kindergartens in Greece reopened on Monday after a two-month closure, as the authorities moved to partially lift a lockdown that has been in place since Nov. 7. The country’s secondary schools and universities remained closed, with lessons being conducted remotely.
The health ministry of the Palestinian Authority has given an emergency authorization to Russia’s Sputnik V vaccine, the health minister, Mai al-Kaila, announced on Monday. The Russian Direct Investment Fund, which financed Sputnik V, said that it expected to deliver the first batch of doses to the Palestinians in February, but it did not say how many it planned to send.
The city of Brisbane, Australia, will lift a strict three-day lockdown enforced last week after a case of the new variant of the coronavirus was recorded. The lockdown will end Monday evening, though masks will remain mandatory in crowded spaces in the city for a further 10 days.
The Paycheck Protection Program was a lifeline for millions of small businesses brutalized by the pandemic. Over a four-month span, the government program distributed $523 billion in forgivable loans to more than five million companies. The average recipient got just over $100,000.
And then there were the roughly 300 business that received loans of $99 or less.
Judith Less, who runs a thrift shop in New Jersey, got $27. Nikki Smith, a baker and caterer in Oregon, collected $96. A.J. Burton, the founder of a record label in Arkansas, got $78. And Susana Dommar, a chiropractor in Texas, received a loan for just $1.
Stephanie Ackerman, a self-employed college admissions consultant, was shocked when her loan deposit, for $13, showed up in her bank account.
“That’s supposed to help my business? It was a joke,” said Ms. Ackerman, whose company, Tomorrow Today College Consulting in Red Bank, N.J., lost months of sales last spring as the coronavirus crisis took hold.
The tiny sums were equally frustrating for the banks and other lenders that made the government-backed loans. For each, they were paid 5 percent of the value — meaning they collected just pennies on the smallest loans, far less than they cost to make. Ms. Ackerman’s loan netted her lender, Bank of America, a fee of 65 cents, paid by the government.
The profusion of minuscule loans is yet another illustration of how the relief program’s hastily constructed rules sometimes led to absurd outcomes. And they’re poised to be repeated: In last month’s stimulus package, Congress allocated $284 billion to restart the loan program, which ended in August, and give a second round of loans to the hardest-hit businesses. Lending is scheduled to begin on Monday.
The N.B.A. postponed a game on Sunday between the Miami Heat and the Boston Celtics when the Heat did not have enough available players because of the league’s coronavirus health and safety protocols. It was the second game of the season postponed after the protocols left a team short-handed.
“Because of ongoing contact tracing with the Heat, the team does not have the league-required eight available players to proceed with tonight’s game against the Celtics,” the league said in a statement.
The Celtics were also missing a significant portion of their roster on Sunday, including their stars. Less than a month in, the season is trending in the wrong direction, with a growing number of players missing games after testing positive for, or potentially being exposed to, the virus.
“We anticipated that there would be game postponements this season and planned this season accordingly,” Mike Bass, a league spokesman, told The New York Times. “There are no plans to pause the season. We will continue to be guided by our medical experts and our health and safety protocols.”
Along with the Celtics and the Heat, the Philadelphia 76ers, the Dallas Mavericks and the Chicago Bulls listed at least three players on their injury reports over the weekend in connection with the league’s virus protocols. Multiple other teams also had at least one player listed, a marked contrast from the N.B.A.’s conclusion to the 2019-20 season at the Walt Disney World campus in Florida over the summer. No games were postponed then, and no players were said to have tested positive.
The league’s injury reports do not say whether a player is out because he has tested positive or was just potentially exposed. A player who tests positive could be isolated for at least 10 days, and one who is exposed could be in quarantine for several days. Each week, the N.B.A. announces how many new players have tested positive. In its most recent report on Wednesday, four players had tested positive, up from zero the week before and two in the first week of play.
“We’re all dealing with a vast set of circumstances, so we’ve got to remain calm, and we’ve always got to have a plan for adversity,” Coach Rick Carlisle said before the Mavericks’ game against the Orlando Magic on Saturday, when Dallas was missing three players because of virus protocols. “We’ve been expecting that this sort of thing was certainly a realistic possibility, and now we’re dealing with it.”